Vos Alexander, Vries Annebeth Meij-de, Smets Anne, Verbeke Jonathan, Heij Hugo, van der Steeg Alida
Pediatric Surgical Center of Amsterdam, Emma Children's Hospital AMC and VU University Medical Center, Box 22660, 1100 DD, Amsterdam, The Netherlands.
Pediatric Surgical Center of Amsterdam, Emma Children's Hospital AMC and VU University Medical Center, Box 22660, 1100 DD, Amsterdam, The Netherlands.
J Pediatr Surg. 2014 Jul;49(7):1153-5. doi: 10.1016/j.jpedsurg.2013.09.011.
In patients with a non-palpable testis (NPT) on physical examination, the testis is assumed either to be situated intra-abdominally or to be hypoplastic or absent. Diagnostic laparoscopy in these boys is considered the preferable first step. In this study the diagnostic value of pre-operative ultrasound for NPT is assessed in comparison with laparoscopy.
All boys aged under the age of 17 years who were diagnosed with an NPT by a pediatric surgeon from 2000 till 2012 were evaluated. All patients of whom clinical, ultrasonographic, and operative findings were available were included.
Ninety-six boys with 117 NPTs were included. With ultrasound 67 testes were detected in the inguinal canal, which was confirmed peroperatively for 61 testes. Of the 15 testes with an intra-abdominal position on ultrasound, 10 were found intra-abdominally during surgery. The positive predictive value of the ultrasonography is 91% for inguinally located testes and 67% for intra-abdominally located testes.
Ultrasonography has a high positive predictive value for inguinally located testes. When ultrasound locates a testis in an inguinal location, a primary inguinal exploration can be considered, preventing an unnecessary diagnostic laparoscopy.
体格检查时未触及睾丸（NPT）的患者，其睾丸被认为要么位于腹腔内，要么发育不全或缺失。对于这些男孩，诊断性腹腔镜检查被认为是首选的第一步。在本研究中，将术前超声对NPT的诊断价值与腹腔镜检查进行比较评估。
对2000年至2012年期间被儿科外科医生诊断为NPT的所有17岁以下男孩进行评估。纳入所有临床、超声和手术结果均可用的患者。
纳入了96名患有117个NPT的男孩。超声检查发现67个睾丸位于腹股沟管，其中61个在手术中得到证实。超声检查显示位于腹腔内的15个睾丸中，10个在手术中被发现位于腹腔内。超声检查对位于腹股沟的睾丸的阳性预测值为91%，对位于腹腔内的睾丸为67%。
超声检查对位于腹股沟的睾丸具有较高的阳性预测值。当超声检查发现睾丸位于腹股沟位置时，可以考虑进行一期腹股沟探查，避免不必要的诊断性腹腔镜检查。
